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By Heron Greenesmith, Andrew Cray, and Kellan Baker May 22, 2013
President Barack Obama signed the Patient Protection and Affordable Care Act, or ACA, into law on March 23, 2010. Many Americans have already benefited from the ACA, and millions more will benefit as the law fully comes into effect. By January 1, 2014, the laws provisions will be underway, ensuring that millions of Americans will be able to afford the health care that they need. This guide will help couples and parents who are lesbian, gay, bisexual, and transgender, or LGBT, understand how the ACA benefits LGBT people and their families. The guide provides a basic overview of the Affordable Care Act, a review of how the act helps you and your family, and an explanation of how you and your family can access affordable health insurance.
1 Center for American Progress | Family Equality Council | The Affordable Care Act and LGBT Families: Everything You Need to Know
Medicaid expansion
The ACA originally expanded Medicaid to cover people who earn up to 138 percent of the federal poverty level.6 While many states are moving toward expanding their Medicaid eligibility for 2014, it is less clear which states will opt not to expand their program at this time. There is no final deadline for state participation in Medicaid expansion. Your states Marketplace will have more information on Medicaid eligibility.
2 Center for American Progress | Family Equality Council | The Affordable Care Act and LGBT Families: Everything You Need to Know
3 Center for American Progress | Family Equality Council | The Affordable Care Act and LGBT Families: Everything You Need to Know
How the law helps families with parents who are LGBT
Affordable health care
The ACA makes sure that affordable health insurance is available in every state to individuals and families who cannot afford expensive care. In general, fewer families with parents who are LGBT have health insurance than families in the general population because many employers do not offer coverage for same-sex partners or their children.16 It can be very costly for parents who are LGBT to insure their entire families. Thanks to the ACA, many more children with parents who are LGBT will be able to access the coverage that they need.
Nondiscrimination
The ACA bans Health Insurance Marketplaces and the plans sold in them from discriminating on the basis of sexual orientation and gender identity. Families with parents who are LGBT will enjoy comprehensive coverage without being discriminated against based on whom they love or what their families look like. Transgender people will also have increased access to coverage without being denied based on their gender identity or expression.17
Pre-existing conditions
The ACA prohibits insurance companies from discriminating against people with preexisting conditions such as cancer and HIV. Before the ACA, transgender people or people living with HIV could be dropped from or denied coverage. After January 1, 2014, people living with HIV will be able to get health coverage that includes their treatment plan, and being transgender will no longer be considered a pre-existing condition.18
4 Center for American Progress | Family Equality Council | The Affordable Care Act and LGBT Families: Everything You Need to Know
parents who are LGBT will still be eligible for tax credits to buy plans that cover their whole family. Marketplaces will open to the public to compare plans in fall 2013, and coverage will start in 2014.
Affordable coverage
The ACAs main goal is to make quality health insurance affordable for all Americans. The ACA guarantees affordable care for all Americans in the following ways:
Medicaid Medicaid is the state-run health insurance option for people with very low income and people with disabilities, as well as some families and children. Each state currently has different standards for Medicaid eligibility. Under the ACA, many states are expanding Medicaid eligibility to cover adults who earn up to 138 percent of the federal poverty level. Starting in the fall of 2013, you will be able to check your Medicaid eligibility through your states Marketplace.19 Tax credits If you or your familys income is not low enough to qualify for Medicaid but is still less than 400 percent of the federal poverty level, you may qualify for a tax credit to help you pay your health insurance premiums. Anyone who qualifies can receive the tax credit as a pre-payment or as a credit on his or her tax return. You will be able to calculate your tax credit when you apply for insurance through the Marketplace in your state.20 Exemptions Starting in 2014 the ACA will provide several exemptions from the shared responsibility payment, the penalty owed for not providing insurance for yourself and your family. The exemptions include being a member of an Indian tribe or a health care sharing ministry or not being able to afford the minimum essential coverage, even with tax credits.21
Healthcare.gov
You can see your current health insurance options on the Department of Health and Human Servicess website, available at http://www.healthcare.gov. The website includes search tools to help you find coverage choices for domestic partners and children. Follow the steps below to find out more:
5 Center for American Progress | Family Equality Council | The Affordable Care Act and LGBT Families: Everything You Need to Know
1. Visit http://finder.healthcare.gov. 2. Answer the questions about your state of residence and what best describes your family situation and health care needs. Indicate if you need coverage for a same-sex partner and for any children. 3. Answer additional questions on the next page about your individual situation. 4. Choose one of the insurance options. Before you choose, you can learn more about every option so that you can make an informed decision about what works for you and your family. All the options are in one place so that you can compare them across several categories.
Resources
Find out more about the difficulty that parents who are LGBT and their children have accessing care and coverage. Read the Center for American Progress and Family Equality Council reports, titled All Children Matter: How Legal and Social Inequalities Hurt LGBT Families and Obstacles and Opportunities: Ensuring Health and Wellness for LGBT Families. Both are available at http://www.children-matter.org. Find out more about the Family Equality Councils work to support health care for all families at http://www.familyequality.org/get_informed/advocacy/health/. Find out more about the Center for American Progresss work to support equality and improved access to health care for LGBT people and families at http://www.americanprogress.org/issues/lgbt/view/. Kellan Baker is the Associate Director of the LGBT Research and Communications Project at the Center for American Progress. Heron Greenesmith is the Legislative Counsel for Family Equality Council. Andrew Cray is a Policy Analyst with the LGBT Research and Communications Project.
6 Center for American Progress | Family Equality Council | The Affordable Care Act and LGBT Families: Everything You Need to Know
Endnotes
1 The Henry J. Kaiser Family Foundation, Establishing Health Insurance Marketplaces: An Overview of StateEfforts (2013), available at http://kff.org/health-reform/issue-brief/ establishing-health-insurance-exchanges-an-overview-of/. 2 Ibid. 3 Federal Subsidies: Helping People Afford Health Care, available at http://101.communitycatalyst.org/aca_provisions/subsidies (last accessed May 2013). 4 Ibid. 5 Timothy Jost, Implementing Health Reform: Shared Responsibility Tax Exemptions And Family Coverage Affordability, Health Affairs Blog, January 31, 2013, available at http://healthaffairs.org/blog/2013/01/31/implementinghealth-reform-shared-responsibility-tax-exemptions-andfamily-coverage-affordability/. 6 Families USA, About Medicaid, available at http://www. familiesusa.org/issues/medicaid/about-medicaid.html (last accessed May 2013). 7 Federal Subsidies: Helping People Afford Health Care. 8 Department of Health and Human Services, Lifetime & Annual Limits, available at http://www.healthcare.gov/law/ features/costs/limits/ (last accessed May 2013). 9 Department of Health and Human Services, Patients Bill of Rights, available at http://www.healthcare.gov/law/ features/rights/bill-of-rights/index.html (last accessed May 2013). 10 Setting Insurance Premiums, available at http://101.communitycatalyst.org/aca_provisions/setting_premiums (last accessed May 2013). 11 Department of Health and Human Services, Womens Preventive Services: Required Health Plan Coverage Guidelines, available at http://www.hrsa.gov/womensguidelines/ (last accessed May 2013). 12 Department of Health and Human Services, Young Adult Coverage, available at http://www.healthcare.gov/law/ features/choices/young-adult-coverage/ (last accessed May 2013). 13 Families USA, About Medicaid. 14 Department of Health and Human Services, Medicare Drug Discounts, available at http://www.healthcare.gov/law/ features/65-older/drug-discounts/index.html (last accessed May 2013). 15 Federal Subsidies: Helping People Afford Health Care. 16 Kellan Baker and Jeff Krehely, Changing the Game: What Health Care Reform Means for Lesbian, Gay, Bisexual, and Transgender Americans (Washington: Center for American Progress, 2011), available at http://www.americanprogress. org/issues/lgbt/report/2011/03/29/9200/changing-thegame/. 17 Andrew Cray and Kellan Baker, Why Gender-Identity Nondiscrimination in Insurance Makes Sense (Washington: Center for American Progress, 2013), available at http://www.americanprogress.org/issues/lgbt/report/2013/05/02/62214/why-gender-identity-nondiscrimination-in-insurance-makes-sense/. 18 Patients Bill of Rights, available at http://www.healthcare. gov/law/features/rights/bill-of-rights/index.html (last accessed May 2013). 19 Families USA, About Medicaid. 20 Federal Subsidies: Helping People Afford Health Care. 21 Jost, Implementing Health Reform.
7 Center for American Progress | Family Equality Council | The Affordable Care Act and LGBT Families: Everything You Need to Know